[Clinical analysis of 16 cases of pulmonary epithelioid hemangioendothelioma].

Objective: To improve the diagnosis and treatment of pulmonary epithelioid hemangioendothelioma (P-EHE). Methods: Sixteen patients diagnosed with P-EHE in Fuzhou Pulmonary Hospital of Fujian Province from January 2009 to July 2020 were collected. Their gender, age, imaging findings, pathological characteristics, treatment protocols, survival and other clinical data were summarized and analyzed. Results: The ratio of male to female among the 16 patients was 1∶1; and the average age of onset was 47.75 years. Most cases of PEHE (9/16) were found by physical examination, while some cases developed respiratory symptoms such as cough, sputum, shortness of breath, hemoptysis, chest pain, etc. (7/16). In most patients the lesions were localized to the lungs (11/16), while bone metastasis (1/16), lymph node metastasis (1/16), and pleural metastasis (4/16) also occurred. The pathological tissues were obtained mainly through surgical thoracoscopy. Chest CT images showed multiple nodules in both lungs, with most of the nodules less than 2.0 cm in diameter, and calcifications were seen, while solitary nodules and masses were rare, and pleural metastases could be manifested as pleural thickening and pleural effusion. The pathological findings were well-defined eosinophilic nodules with irregularly arranged nest-like structures. Those eosinophilic nodules had few central cells and abundant peripheral cells, which extended into the alveolar cavity like papillae. The tumor cells were epithelioid with small atypia, and vacuoles and red blood cells could be seen in the cytoplasm of individual tumor cells. Immunohistochemically, the tumor cells were positive to CD34, CD31, Factor Ⅷ andvimentin (VIM). Follow-up of 0.5 to 11 years showed that four patients died, two lost to follow-up, and the rest of the patients were in good condition, with a median overall survival (OS) of 4.58 years. Conclusions: PEHE is a rare low-grade lung tumor with no specific clinical manifestations. It can be diagnosed with chest imaging and pathological immunohistochemistry. Moreover, there is currently no standard treatment for PEHE, and most patients have a good prognosis.

[Analysis of 9 cases of nodular type of pulmonary cryptococcosis with coexisting lung cancer confirmed by pathological examinations].

Objective: To describe the characteristics of the nodular type of pulmonary cryptococcosis (PC) with coexisting lung cancer. Methods: A total of 9 cases of PC with coexisting lung cancer, admitted to Fuzhou Pulmonary Hospital of Fujian from 1st January 2009 to 31th December 2016, and confirmed by pathological examinations, were studied and the related literature were reviewed. Results: The patients consisted of 1 male and 8 females, with a mean age of (53±10) years (range, 38 to 68 years). Four patients (44.4%) had underlying diseases, 3 with diabetes mellitus and 1 with gastric cancer surgery. The main clinical manifestations of most cases were cough and phlegm. The lesions of PC on chest CT were mostly solitary or multiple nodules with a diameter < 1 cm, and the lesions of carcinoma were shown as solitary nodules with a variety of signs suggestive of malignancy. All the patients were confirmed to have concomitant PC and lung adenocarcinoma by pathological examinations. Lung cancer stage was early (Tis and Ⅰ-Ⅱ) in 88.9 % (8 cases) of the cases. All the patients received surgery and postoperative medical therapy. The prognosis was relatively good in most of them except 1 case with death due to lung cancer metastasis and 1 case with lung cancer recurrence. Conclusions: Coexistence of PC and lung cancer is rare and the clinical symptoms are not specific. When PC coexists with carcinoma and manifests as pulmonary nodule, it mimics malignant lesions and is extremely easy to be misdiagnosed. Therefore PC must be considered in the differential diagnosis of pulmonary nodules.

[Clinical application and evaluation of an early non-sedation protocol for critically ill respiratory patients].

Objective: To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU). Methods: Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group; n=35) or with daily interruption of sedation (DIS) (control group; n=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared. Results: Patients in the intervention group had a shorter duration of mechanical ventilation than those in the control group [(7±5) vs (11±9) d, P<0.05] and were discharged from the RICU [(9±7) vs (18±9) d, P<0.05] and hospital earlier [(17±14) vs (29±22) d, P<0.05] than those in the control group. The doses of midazolam were significantly lower in the intervention group than in the control group [(99±104) vs (482±337) mg, P<0.05]. The RICU and hospitalization expenses were both significantly lower in the intervention group than in the control group [53(84) vs 88(173), 72(195) vs 154(234) thousand CHY, P<0.05]. In the intervention group, the occurrence rates of ventilator associated pneumonia (23% vs 46%), tracheotomy (14% vs 37%) and gastrointestinal adverse reactions (17% vs 40%) were significantly lower than those in the control group (P<0.05). No differences were recorded in RICU and hospital mortality (P>0.05). The occurrence rates of unplanned extubation and reintubation and the need for CT brain scans were similar in the 2 groups (P>0.05). The levels of cardiac, liver and renal damage markers, lactic acid and C-reactive protein were the same in both groups (P>0.05). Conclusions: The early non-sedation protocol decreased the duration of mechanical ventilation and the length of stay in the RICU and hospital, and it did not increase the incidence of complications and adverse events.

[Retrospective analysis of 117 cases of pulmonary cryptococcosis].

Objective: To investigate the clinical features of pulmonary cryptococcosis(PC). Methods: A total of 117 cases of PC, confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2009 to December 2013, were studied. Results: The patients consisted of 75 males and 42 females, with a mean age of (44.1±13.7) years (range, 16 to 76 years). Thirty-eight cases were immunocompromised hosts (ICH) and 79 cases were non-immunocompromised hosts (NICH). The clinical symptoms of most patients were mild and the main clinical manifestations were cough and sputum production. The chest CT manifestations were as follows: nodular or mass-like shadows in 66, patchy infiltrates or consolidation in 34, and mixed lesions in 17 cases. There were a variety of CT signs accompanied, with halo sign (78 cases) and proximal air bronchogram (63 cases) being the most common. These two signs were more common in NICH than ICH (77.2%, 44.7%, P=0.001; 60.8%, 39.5%, P=0.047). They were also more likely to be seen in the patchy infiltrates or consolidation and mixed patterns than in nodular or mass-like type of PC(82.4%, 82.4% and 54.5%, P=0.007; 76.5%, 82.4% and 33.3%, P=0.000), while lobulation sign, spicule sign and pleural indentation were more likely to be seen in the latter(0%, 5.9% and 30.3%, P=0.000; 0%, 5.9% and 27.3%, P=0.000; 0%, 5.9% and 19.7%, P=0.005). The lesions of PC were mainly found in the right lung and lower lobes. The lesions in NICH were more commonly seen in multiple lobes than ICH. Enhanced CT scanning was performed in 38 patients, and 24 cases showed uniform enhancement and 27 moderate enhancement. The diagnosis was confirmed in all cases by pathological findings. A hundred and one cases were treated and carefully followed in our hospital except 16 cases who were lost for follow-up. Seventy-one were cured and 30 were improved. Conclusions: The clinical symptoms of PC were diverse and nonspecific. Halo sign and proximal air bronchogram are helpful for the diagnosis of PC. The outcome of most patients was satisfactory after appropriate treatment.

Novel alternatives to antibiotics: bacteriophages, bacterial cell wall hydrolases, and antimicrobial peptides.

Extensive research has been conducted on the development of three groups of naturally occurring antimicrobials as novel alternatives to antibiotics: bacteriophages (phages), bacterial cell wall hydrolases (BCWH), and antimicrobial peptides (AMP). Phage therapies are highly efficient, highly specific, and relatively cost-effective. However, precautions have to be taken in the selection of phage candidates for therapeutic applications as some phages may encode toxins and others may, when integrated into host bacterial genome and converted to prophages in a lysogenic cycle, lead to bacterial immunity and altered virulence. BCWH are divided into three groups: lysozymes, autolysins, and virolysins. Among them, virolysins are the most promising candidates as they are highly specific and have the capability to rapidly lyse antibiotic-resistant bacteria on a generally species-specific basis. Finally, AMP are a family of natural proteins produced by eukaryotic and prokaryotic organisms or encoded by phages. AMP are of vast diversity in term of size, structure, mode of action, and specificity and have a high potential for clinical therapeutic applications.

An iterative method of ultrasonic reflection mode tomography.

Based on the Fourier slice theorem used in X-ray tomography and paraxial approximation, an iterative method was developed to eliminate the influence of wavefront curvature on reconstructed images. Computer simulations showed that the quality of reconstructed images was apparently improved by using the method. In comparison with already existing methods, the present method is more practical and can be used for limited angle reflection mode tomographic imaging.

[Characteristics of CDDP-PLA microspheres in vitro and in vivo].

Studies on the drug release in vitro and hepatic arterial chemoembolization in vivo were carried out with the newly developed CDDP-PLA microspheres. The mechanism of the in vitro release was shown to conform to Higuchi equation. After chemoembolization the CDDP-PLA microspheres showed remarkably lower CDDP concentrations in the general circulation and much higher concentrations in the hepatic tissue e. g. up to 21.55 +/- 12.18 micrograms/g at 8 h, which is much higher than that (3.16 +/- 0.09 micrograms/g) of the CDDP in hepatic arterial infusions. Thus, the CDDP-PLA microspheres may improve the curative effects and lower the side effects, especially the kidney toxicity, of the anticancer drug cisplatin.

[Studies on chemical constituents in the root of Desmos grandifolius (I)].

OBJECTIVE: To investigate new compounds with anti-tumor activities from the root of Desmos grandifolius of Annonaceae. METHOD: The chemical constituents were isolated by silica gel column chromatography, and the structures were elucidated by UV, IR, MS, 1H NMR, 13C NMR, H-H COSY and NOESY analysis. RESULTS: Six compounds have been isolated from the CHCl3 extract of this plant and identified as lawinal(I), isolawinal(II), desmethoxymatteucinol(III), benzoic acid(IV), beta-sitosterol(V) and sitgmasterol (VI). CONCLUSION: All compounds were found from this plant for the first time. Three dihydroflavonoids isolated from this species are characterized by A-ring substitution and no B-ring substitution.